HAS THE AHLBÄCK CLASSIFICATION BEEN ACCURATELY DESCRIBED AND CITED?

Gali, Julio Cesar; de Novais, Igor Silva; Carletti, Leonardo Altieri; Cruz, Pedro Rinaldi Alves; Caetano, Edie Benedito

doi:10.1590/1413-785220253306e296115

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Systematic Review/Knee • Acta Ortop Bras 33 (6) • 2025 • https://doi.org/10.1590/1413-785220253306e296115 linkcopy

HAS THE AHLBÄCK CLASSIFICATION BEEN ACCURATELY DESCRIBED AND CITED?

A CLASSIFICAÇÃO DE AHLBÄCK TEM SIDO DESCRITA E CITADA CORRETAMENTE?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The classification of knee osteoarthritis allows assessment of disease severity and may be useful in guiding treatment decisions. One of the most widely used systems for this purpose is the Ahlbäck classification. This study aimed to compare the original description of the Ahlbäck classification with how it has been reported and cited by other authors in subsequent publications. We conducted a search in the PubMed, Embase, and Cochrane databases for articles containing exclusively the terms "knee", "osteoarthritis", "osteoarthrosis", and "Ahlbäck classification". After applying the inclusion and exclusion criteria, 64 articles remained. These articles were analyzed in two aspects: the description of the Ahlbäck classification (categorized as correct, partially correct, or incorrect) and the accuracy of the reference citation (correctly or incorrectly cited). Only 10 articles (15.6%) correctly described the Ahlbäck classification and cited the original source properly. In contrast, 37 publications (58.4%) contained errors both in the description of the classification and the citation. Conversely, 37 publications (58.4%) contained errors both in the description of the classification and in the bibliographic reference. The proportion of articles that accurately described and cited the Ahlbäck classification was markedly low, comprising only 15.6% of those included in this systematic review. Level of Evidence III; Systematic Review.

Keywords:
Knee; Osteoarthritis; Ahlbäck Classification

Authors	Year of publication	Correct classification	Incorrect classification	Correct citation	Incorrect citation
Lindberg & Montgomery⁵	1987	•		•
Lysholm et al.⁴⁰	1987		•		•
Bert et al.⁴¹	1989		•		•
Barrett et al.¹⁴	1990	•		•
Keyes et al.⁵⁴	1992		•		•
Rockborn et al.¹⁹	1996	•			•
Petersson et al.²⁰	1997	•			•
Sahlström et al.⁶	1997	•			•
Petersson et al.⁵⁵	1997		•		•
Sahlström et al.²¹	1997		•		•
Larsson et al.²²	1998	•			•
Gillquist & Messner⁴²	1999		•		•
Davies et al.¹⁵	1999	•		•
Gidwani et al.⁴⁴	2003		•		•
Hung et al.⁴⁵	2003		•		•
Galli et al.⁸	2003		•		•
Rademakers et al.⁴⁶	2004		•	•
Tang et al.²³	2004	•			•
Tang et al.²⁴	2005	•			•
Sisto & Mitchell ¹⁶	2005	•		•
Weidow et al.⁴	2006	•		•
Sisto & Sarin ¹⁷	2006	•		•
Kijowski et al.³⁶	2006		•		•
Hing et al.¹⁸	2007	•		•
Rademakers et al.⁴⁷	2007		•		•
Beard et al.⁴⁸	2007		•		•
Becker et al.⁴⁹	2008		•		•
Lidén et al.²⁵	2008	•			•
Rademakers et al.⁵⁰	2009		•		•
Turajane et al.²⁶	2009	•			•
Ventura et al.⁵⁶	2010		•		•
Parmaksizoğlu et al.²⁷	2010	•			•
McDonnell et al.⁵⁷	2011		•		•
Marcacci et al.⁵¹	2011		•		•
Brucker et al.⁵²	2011		•	•
Hernández-Vaquero et al.¹⁰	2012		•		•
Moon et al.²⁸	2013	•			•
Staikos et al.²⁹	2013	•		•
Wright et al.⁹	2014		•		•
Waldstein et al.³⁷	2014		•		•
Li et al.³⁰	2015	•		•
Garrido et al.³¹	2015	•		•
Ghinelli et al.³⁸	2016		•		•
Martins et al.⁵⁸	2016		•		•
Talic-Tanovic et al.³²	2017	•			•
Skou et al.³³	2017	•			•
Köse et al.¹¹	2018		•		•
Belk et al.⁵⁹	2018		•		•
Elveos et al.⁶⁰	2018		•		•
Kinsey et al.⁴³	2018		•		•
Lim et al.⁶¹	2019		•		•
Keenan et al.¹	2020		•		•
Identeg et al.⁵³	2020		•		•
Albergo et al.³⁹	2020		•		•
Wing et al.⁶²	2021		•		•
Pedersen et al.⁶³	2021		•	•
Jarecki et al.⁶⁴	2021		•		•
Eckersley et al.⁶⁵	2021		•		•
Zambianchi et al.⁶⁶	2021		•		•
Jarecki et al.⁶⁷	2022		•		•
Nakayama et al.⁷	2023		•		•
Obara et al.³⁴	2023	•			•
Törnblom et al.³⁵	2024	•			•
Schippers et al.⁶⁸	2024		•		•
		1	2	3	4
		24	40	13	51
		37.50%	62.50%	20.31%	79.69%

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Grade 1	Moderate cartilage destruction (joint space narrowing)
Grade 2	Complete cartilage destruction (joint space obliterated or nearly obliterated)
Grade 3	Minor bone attrition (<0.5 cm)
Grade 4	Moderate bone attrition (between 0.5 and 1.5 cm)
Grade 5	Severe bone attrition (>1.5 cm)